Anticougulation Therapy in Europe

[jeffp]

In the early years, it was normal for people to go off warfarin after a few month. It wasn't till my second valve and a TIA that my cardiologist "suggested" I go on ACT. That was seven years after my first AVR. Al can tell you stories of much longer than that with no ACT. Of course, even today people on ACT get strokes. You never know- I would have to see ironclad evidence that ACT made no difference before I would consider going off warfarin- No make that GOLDPLATED!

I'd have to agree. Patients without artificial valves get cardogenic strokes as well. The On-X has very good hemodynamic characteristics and probably is less throbogenic than others out there, but still not as good as the original equipment. I've had little problems with the side effects of ACT, so the increased risk without ACT wouldn't be worth it in my opinion. Studies will weigh the risk for the few that have problems against the many that have to take ACT and the effects from that. If it is more cost efficient to not have the cost of the ACT and potential bridging, bleeding care, management, etc, and to have a few people over the normal rate stroke, they can make a good case to stop ACT (but not from the view of the few unlucky ones). It's a no brainer for me, since I have a MVR, I'd still be on ACT regardless of the valve maker. Like RCB said, it would have to be goldplated - No make that SOLID GOLD!

 

[terryj]

My husband has the ATS valve in the aortic position and his INR range is 2.0 to 3.0 We still feel more comfortable when it is 2.5 to 3.5.

 

[Guest]

When On-X first contacted me several years ago it was with the claim that their carbon was slicker than the material used in the other valves. Therefore, clots were less likely to form on their valves than on others. However, it seems to me now that the problem is not so much clots forming on the valves themselves but the fact that the valves do not work like the original models. If you think of a valve as a double door with hinges on the walls that extend behind the door when it is open you have a pretty good analogy. In the normal heart these valves are not flat but more like a fish's fins that can flap a little. The flapping motion plus the squeezing action of the heart keeps the blood from stagnating behind the door. Artificial valves are flat and the sewing cuff decreases the effectiveness of the squeezing action. This increases the risk of stagnating blood between the valve and the wall of the heart. This seems to be the greatest risk with a valve. Warfarin prevents clots in stagnant blood situations. Aspirin prevents clots in high pressure blood flow and high shear-force situations. The American College of Chest Physicians now recommends against the use of aspirin to prevent clots in stagnation situations. So it doesn't seem logical to me that aspirin would prevent clots with an On-X valve better than it would with a St. Jude or Medtronics etc.

Before someone comes up with the statement that I am just hoping to keep my job in a warfarin clinic (buggy whip factory), look at my member profile. You will see that I will be 64 years old in less than two months. So, whatever the outcome, I will likely be retired before the question is answered.

I'm just cautioning against making a decision about a valve based on what might be. If you already have a valve, you can put big money on a bet that in 2010 you will still be taking warfarin.

 

[Troy]

I was considering the ONX valve and the ONX people told me the asprin trial in Germany was discontinued because there was a new trial in the US with asprin and Plavix. (?) There was some information, on the web, when the German asprin study was started, then nothing. I bet the results weren't what they had hoped for.

 

[sue943]

My two valves are ATS and my INR range is 3.0 - 4.0, I take my warfarin like a good little girl. I live in Europe and had my OHS in London.

 

[Guest]

These trials ordinarily have an independent review board. They review the results as the study is ongoing. It is quite serious to stop a trial before the end point is reached. The only reason that I have ever heard of it being done is that there was a statistically significant harm done to the people in the experimental group as compared to the controlled group.

I must add that I have not seen any reports on this, I am just commenting on what has been mentioned on this forum.